Admission Temperature Research Articles

Decreasing delivery room intubations: A quality improvement project.

The delivery room intubation rate for babies born less than 32 weeks postmenstrual age (PMA) at the Mater Mothers' Hospital in 2017 was 51%. Delivery room intubation of preterm infants may be associated with an increased risk of developing bronchopulmonary dysplasia. This quality improvement project aimed to decrease the rate of delivery room intubation for infants born less than 32 weeks PMA. A quality improvement process using the evidence-based practice for improving quality framework and Plan-Do-Study-Act cycles was undertaken from October 2018 to December 2019. Commencing bubble continuous positive airway pressure for initial resuscitation in the delivery room was the principal change idea. The delivery room intubation rate for infants born less than 32 weeks PMA before the commencement of this project was 48% (cohort 1, n=221). There was a significant decrease in the rate to 37.2% while the project was being conducted (cohort 2, n=277) and a further significant reduction to 28.2% after introducing bubble continuous positive airway pressure in the delivery room (cohort 3, n=202). There was a significant improvement in admission temperatures and a significant decrease in mortality rate between cohort 1 and cohort 2 but not between cohort 2 and cohort 3. There was no change in the rate of discharge home on oxygen between cohorts. This quality improvement project led to a significantly decreased delivery room intubation rate in infants born less than 32 weeks PMA. There was no evidence of any adverse outcomes with this approach.

Benefits of Passive Warming on Surgical Patients Undergoing Regional Anesthetic Procedures

Introduction Perioperative normothermia is vital to reduction of surgical morbidity and mortality and improved surgical patient outcomes. Preoperative patient warming with active or passive warming measures is a key factor to maintaining normothermia throughout the perioperative process. Identification of the problem Potential for development of perioperative hypothermia is associated with use of regional anesthetic procedures (RAPs). Use of active warming during RAP placement is not feasible because of sterility requirements and patient positioning during RAP placement. QI question/Purpose of the study To determine if application of preoperative passive warming methods would maintain body temperature in patients receiving RAPs and contribute to reduced length of stay in PACU at a Level 1 trauma center in Middle Tennessee. Methods After being deemed IRB Exempt, this QI project utilized a convenience sample of 120 patients receiving RAP in conjunction with an elective orthopedic, abdominal, or thoracic surgical procedure. Passive warming trial: 53 patients received warming via thermal insulated surgical cap ($1.54/ea) & activated chemical warmer ($0.54/ea) placed on the inner, upper aspect of one arm. Retrospective review: 67 patients received warming using forced warm air gown ($9.75/ea). All preoperative warming measures remained in place approximately 90 minutes. Tympanic temperature was assessed upon admission, at transfer to OR, after induction of general anesthesia, and upon arrival to PACU. Outcomes/Results No difference in mean temperatures was found between groups post-induction or upon admission to PACU. Additionally, 51.9% of passive group (n = 28) experienced an increase in temperature compared to 48.2% (n = 26) of retrospective group. A statistically significant, positive correlation was found between admission temperature and transfer to OR temperature with age (p = 0.18). Passive group averaged 13.5-minute shorter PACU LOS. Discussions Passive warming affords the RAP population opportunity to receive benefits of pre-operative warming. Older participants responded better to passive warming measures: as age increased, temperature also increased. Passive warming measures were found to be less expensive than forced-air systems (savings of > $7 per patient). Conclusions Passive warming methods maintained patient temperatures throughout the perioperative process. Additionally, passive warming demonstrated a statistically significant increase in temperature from admission to transfer to OR in older participants and a clinically significant decrease in PACU LOS. Implications for Perianesthesia Nurses and Future Research Passive warming is a suitable, cost-effective alternative when forced-air warming is not feasible. Additional inquiry into the use of passive warming is warranted. Perioperative normothermia is vital to reduction of surgical morbidity and mortality and improved surgical patient outcomes. Preoperative patient warming with active or passive warming measures is a key factor to maintaining normothermia throughout the perioperative process. Potential for development of perioperative hypothermia is associated with use of regional anesthetic procedures (RAPs). Use of active warming during RAP placement is not feasible because of sterility requirements and patient positioning during RAP placement. To determine if application of preoperative passive warming methods would maintain body temperature in patients receiving RAPs and contribute to reduced length of stay in PACU at a Level 1 trauma center in Middle Tennessee. After being deemed IRB Exempt, this QI project utilized a convenience sample of 120 patients receiving RAP in conjunction with an elective orthopedic, abdominal, or thoracic surgical procedure. Passive warming trial: 53 patients received warming via thermal insulated surgical cap ($1.54/ea) & activated chemical warmer ($0.54/ea) placed on the inner, upper aspect of one arm. Retrospective review: 67 patients received warming using forced warm air gown ($9.75/ea). All preoperative warming measures remained in place approximately 90 minutes. Tympanic temperature was assessed upon admission, at transfer to OR, after induction of general anesthesia, and upon arrival to PACU. No difference in mean temperatures was found between groups post-induction or upon admission to PACU. Additionally, 51.9% of passive group (n = 28) experienced an increase in temperature compared to 48.2% (n = 26) of retrospective group. A statistically significant, positive correlation was found between admission temperature and transfer to OR temperature with age (p = 0.18). Passive group averaged 13.5-minute shorter PACU LOS. Passive warming affords the RAP population opportunity to receive benefits of pre-operative warming. Older participants responded better to passive warming measures: as age increased, temperature also increased. Passive warming measures were found to be less expensive than forced-air systems (savings of > $7 per patient). Passive warming methods maintained patient temperatures throughout the perioperative process. Additionally, passive warming demonstrated a statistically significant increase in temperature from admission to transfer to OR in older participants and a clinically significant decrease in PACU LOS.

Factors associated with treatment outcomes of patients hospitalized with severe maxillofacial infections at a tertiary center

ObjectivesThe purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea.Materials and MethodsA retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses.ResultsAverage LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis.ConclusionFor successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

Quality of targeted temperature management and outcome of out-of-hospital cardiac arrest patients: A post hoc analysis of the TTH48 study

BackgroundNo data are available on the quality of targeted temperature management (TTM) provided to out-of-hospital cardiac arrest (OHCA) patients and its association with outcome. MethodsPost hoc analysis of the TTH48 study (NCT01689077), which compared the effects of prolonged TTM at 33 °C for 48 h to standard 24-h TTM on neurologic outcome. Admission temperature, speed of cooling, rewarming rates, precision (i.e. temperature variability), overcooling and overshooting as post-cooling fever (i.e. >38.0 °C) were collected. A specific score, ranging from 1 to 9, was computed to define the “quality of TTM”. ResultsOn a total of 352 patients, most had a moderate quality of TTM (n = 217; 62% — score 4–6), while 80 (23%) patients had a low quality of TTM (score 1–3) and only 52 (16%) a high quality of TTM (score 7–9). The proportion of patients with unfavorable neurological outcome (UO; Cerebral Performance Category of 3–5 at 6 months) was similar between the different quality of TTM groups (p = 0.90). Although a shorter time from arrest to target temperature and a lower proportion of time outside the target ranges in the TTM 48-h than in the TTM 24-h group, quality of TTM was similar between groups. Also, the proportion of patients with UO was similar between the different quality of TTM groups when TTM 48-h and TTM 24-h were compared. ConclusionsIn this study, high quality of TTM was provided to a small proportion of patients. However, quality of TTM was not associated with patients’ outcome.

Modifiable and Nonmodifiable Factors Contributing to Hypothermia Among High Risk Neonates at Admission to NICU—A Prospective Observational Study

Background: Hypothermia is a well-known contributor to neonatal morbidity and mortality, especially for preterm and low-birth weight neonates. Identifying the predictors for admission hypothermia which are specific to the settings is important to initiate quality improvement projects and improve clinical outcomes. Methods: Study was conducted over a period of 6 months from 1 April to 31 September 2018. All inborn infants needing neonatal intensive care unit (NICU) admission were eligible for the study. The study involved measuring temperatures at exit from delivery room (DR) and at admission to NICU. Hypothermia was defined as core admission temperature <36.5°C. The data collected included all modifiable and nonmodifiable risk factors for hypothermia in newborns. Data was analyzed using logistic regression to determine associations, if any, between admission hypothermia and maternal, neonatal, and environmental characteristics. Results: One hundred and ninety-three infants were enrolled in the study. The incidence of admission hypothermia (<36.5°C) was 83.9%. Forty-four (22.8%) infants had mild hypothermia, 61.1% infants had moderate hypothermia, and none of the neonates had severe hypothermia. Nonmodifiable factors affecting admission temperature were birth weight/gestational age and mother’s temperature before shifting to DR. DR temperature strongly predicted the admission temperature and every 1°C increase in DR temperature improved the rate of admission hypothermia by 34%. Conclusion: Significant proportion of neonates is hypothermic at the time of admission to NICU. DR temperature significantly predicts hypothermia at admission in neonates needing NICU admission.

Observational study using video recordings to explore the first hour after admission to a neonatal intensive care unit.

To explore the admission process to our neonatal intensive care unit. A first phase quality improvement initiative was conducted. We utilised observational video recording of a convenience sample of inborn admissions. Two remote GoPro cameras were placed, one giving an overview of activity and the other focussed on the infant. Recordings captured the first hour after admission including transfer to the neonatal intensive care unit by the birthing team. The video footage of each case study was reviewed by a multidisciplinary panel using an agreed semi-quantitative analysis of events. Ten admissions to the neonatal intensive care unit were video recorded between June and October 2018. Gestational age 282 -401 . A focus on maintaining airway support was inconsistent as was the ability to provide continuous monitoring of vital signs. Overall leadership of the process was lacking and handover often appeared fragmented. Median temperature on admission was 362 (354 -373 ) °C. Vascular access and fluid management occurred at a median of 36 (13-67) minutes. Planning and approval for this study were protracted, particularly negotiating the use of video recording. Anecdotally, this delay is thought to have contributed to an improvement in managing admissions, particularly when maintaining airway support and monitoring. However, our baseline data have highlighted a lack of leadership, fragmented handover, low admission temperatures and broad time frames to achieve vascular access. A guideline to streamline handover and nursery transition is currently being implemented; a subsequent evaluation cycle is planned.

Nosological Differences in the Nature of Punctate White Matter Lesions in Preterm Infants.

Background: The pathogenesis of punctuate white matter lesions (PWMLs), a mild form of white matter damage observed in preterm infants, is still a matter of debate. Susceptibility-weighted imaging (SWI) allows to differentiate PWMLs based on the presence (SWI+) or absence (SWI–) of hemosiderin, but little is known about the significance of this distinction. This retrospective study aimed to compare neuroradiological and clinical characteristics of SWI+ and SWI– PWMLs.Materials and Methods: MR images of all VLBW infants scanned consecutively at term-equivalent age between April 2012 and May 2018 were retrospectively reviewed, and infants with PWMLs defined as small areas of high T1 and/or low T2 signal in the periventricular white matter were selected and included in the study. Each lesion was analyzed separately and characterized by localization, organization pattern, and distance from the lateral ventricle. Clinical data were retrieved from the department database.Results: A total of 517 PWMLs were registered in 81 patients, with 93 lesions (18%) visible on SWI (SWI+), revealing the presence of hemosiderin deposits. On univariate analysis, compared to SWI- PWML, SWI+ lesions were closer to the ventricle wall, more frequently organized in linear pattern and associated with lower birth weight, lower gestational age, lower admission temperature, need for intubation, bronchopulmonary dysplasia, retinopathy of prematurity, and presence of GMH-IVH. On multivariate analysis, closer distance to the ventricle wall on axial scan and lower birth weight were associated with visibility of PMWLs on SWI (p = 0.003 and p = 0.0001, respectively).Conclusions: Our results suggest a nosological difference between SWI+ and SWI– PWMLs. Other prospective studies are warranted to corroborate these observations.

Body temperature, heart rate and long-term outcome of cooled infants: an observational study.

Therapeutic hypothermia is a standard of care for neonatal encephalopathy; however, approximately one in two newborn infants fails to respond to this treatment. Recent studies have suggested potential relationships between body temperature, heart rate and the outcome of cooled infants. The clinical data of 756 infants registered to the Baby Cooling Registry of Japan between January 2012 and December 2016 were analysed to assess the relationship between body temperature, heart rate and adverse outcomes (death or severe impairment at 18 months corrected age). A lower body temperature at admission was associated with adverse outcomes in the univariate analysis (P < 0.001), the significance of which was lost when adjusted for the severity of encephalopathy and other covariates. A higher body temperature during cooling and higher heart rate before and during cooling were associated with adverse outcomes in both univariate (all P < 0.001) and multivariate (P = 0.012, P < 0.001 and P < 0.001, respectively) analyses. Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling, whereas causal relationships between slightly higher temperatures during cooling and adverse outcomes need to be elucidated in future studies. In a large cohort of encephalopathic newborn infants, dual roles of body temperature to the outcome were shown; adverse outcomes were associated with a lower body temperature at admission and higher body temperature during cooling. A higher heart rate before and during cooling were associated with adverse outcomes. Severe hypoxia-ischaemia might be a common causative of faster heart rates before and during cooling and low body temperature before cooling. The exact mechanism underlying the relationship between slightly higher body temperature during cooling and adverse outcomes remains unknown, which needs to be elucidated in future studies.

Damped Oscillators within the General Theory of Casimir and van der Waals Forces

It is demonstrated that the general theory of Casimir and van der Waals forces describes the interaction-induced equilibrium thermodynamic potentials of the damped harmonic oscillator bilinearly coupled to the environment. An extended model for a damped oscillator is suggested along the lines of the general theory of Casimir and van der Waals forces, and the corresponding thermodynamic quantities obtained. While the original model involves a heat bath consisting of a large number of free oscillators having infinitesimal damping functions, the extended model allows any generally admissible frequency and temperature dependent dissipative susceptibilities of the heat bath constituents, influenced by the additional dissipative environmental channels that are not directly linked to the system oscillator. Consequently, the results obtained are applicable to the frequency and temperature dependent damping function of the system oscillator.

Reducing Admission Hypothermia in Neonates Born at Less Than 32 Weeks or 1500 g.

The purpose of this quality improvement project was to decrease admission hypothermia in neonates born at less than 32 weeks or less than 1500 g. At delivery, neonates born less than 1500 g or at less than 32 weeks received polyurethane bags, polyurethane hats, and chemical mattresses. New practice guidelines from 2016 promoted this practice for all neonates born at less than 32 weeks, but the authors' prior work indicated that all neonates born less than 1500 g were at risk (regardless of gestational age) and would benefit from these interventions. After the intervention, only 2.1% (n = 2) of neonates born less than 1500 g or at less than 32 weeks were admitted moderately hypothermic (<36°C) compared with 9.6% in 2016, 20.2% in 2015, and 32.4% in 2014. Overall, the mean admission temperature in 2017 was 37°C, improved from 36.6°C in 2016, 36.3°C in 2015, and 36.2°C in 2014 (P < .001). The intervention significantly reduced the number of neonates admitted moderately hypothermic (<36.0°C) to this neonatal intensive care unit. Using chemical mattresses and polyurethane bags with neonates born less than 1500 g or at less than 32 weeks (compared with only <1000 g) improved admission temperatures. It is important to include all neonates born less than 1500 g in these practice interventions and not only those born at less than 32 weeks; both gestational age and weight should guide practice. More research is needed on the effects of thermoregulation interventions and hyperthermia in neonates, as well as best practice thermoregulation interventions for preterm and ill neonates of all gestational ages and weights.

Hypothermia reduction during neonatal transport in a tertiary care center in South India: a quality improvement initiative

Background: Each degree drop in target temperature at admission increases mortality by 28% in neonates. Maintenance of target temperature during neonatal transport and at admission will pose an enormous challenge in developing countries due to various factors. The objective of the study was to decrease the incidence of hypothermia in transported babies at admission by 50% from a baseline of 64% over 12 months period. Prospective cohort study by QI methodology.Methods: Neonates transported to NICU from March 2019 – February 2020 were included. A baseline data was collected retrospectively to determine the incidence of existing hypothermic babies at admission. Problems were identified using Fishbone analysis. Evidence-based changes were implemented as per local needs in the Plan-Do Study cycle (PDSA) cycles.Results: A total of 96 babies were transported (62 babies during implementation, 34 during the sustenance Phase) during the study period. The mean (SD) gestation and birthweight was similar in the two groups. The distance travelled in kilometres in the hypothermic group was significantly more 7.3 (5.5) compared to the normothermic group 4.1(3.8) (p,0.01). We reduced the incidence of hypothermia from 64% to 16% over 12 months from the time of implementation. There was no correlation seen noted between hypothermia at admission and gestational age (r, - 0.18), birthweight (r, 0.04), or distance travelled in kilometres (r, 0.02). However, there was a positive correlation seen between adherence to the ‘5 Point -protocol’ and admission temperature (r, 0.86).Conclusions: Thermoregulation during neonatal transport is a huge challenge especially in the Indian scenario due to multiple incorrigible factors contributing to its high incidence even in the best of the centres. QI initiatives is a way forward to deal with some of these aspects. Involving the nursing team who forms the core team of neonatal transport is imperative.

Neonatal mortality and its associated factors among neonates admitted at public hospitals, pastoral region, Ethiopia: A health facility based study.

BackgroundNeonatal mortality is a public health issue in, Ethiopia. Unfortunately, the issue is noticeably under-reported and underestimated, so the true gravity of the situation cannot be acknowledged in developing regions of the country. Regrettably, there is no single study to show the rates and predictors of neonatal mortality for Afar region. Thus, this study aims to assess neonatal mortality and associated factors in Afar region, Ethiopia.MethodsA health facility-based cross-sectional study was conducted on 403 neonates admitted to the neonatal intensive care units (NICUs) from January 2015 to December 2019. Maternal and neonatal medical records were reviewed and audited using structured data extraction checklist. The data was collected by four trained nurses and midwives. The medical records were selected using a systematic random sampling technique. Bivariate and multivariable logistic regression analyses were done. Adjusted odds ratio with the corresponding 95% confidence interval were used to assess the association between neonatal mortality and the associated factors. Finally, the statistical significance level was declared at a p-value of less than 0.05.ResultsIn this study, 391 medical records of newborns were included with the data complete rate of 97.02%. The prevalence of neonatal mortality was 57 (14.6%) [95% CI 11.0%-18.4%]. A multivariable logistic regression showed that lack of antenatal care (ANC) follow up [AOR = 4.69: 95%CI (1.77, 12.47)], giving birth through cesarean section [AOR 3.59, 95%CI (1.22, 10.55)], having admission temperature less than 36.5°C [AOR 10.75, 95%CI (3.75, 30.80)], birth asphyxia [AOR 7.16, 95%CI (2.22, 23.10)], and having a length of stay greater than five days in the hospital [AOR 0.23, 95%CI (0.08, 0.66)] were significantly associated with neonatal mortality.ConclusionThis study revealed that the rate of neonatal mortality is still high compared to the national data. Antenatal care, cesarean section delivery, length of stay in the hospital, low temperature at admission and birth asphyxia were factors associated with neonatal mortality. Thus, the health facilities should give due attention to improve antenatal care, intrapartum care and standardized care for admitted neonates. Furthermore, prospective studies are recommended.

Predictive Relevance of Early Temperature Elevation on the Risk of Delayed Cerebral Ischemia Development Following Aneurysmal Subarachnoid Hemorrhage

Fever in aneurysmal subarachnoid hemorrhage (aSAH) has been associated with delayed cerebral ischemia (DCI), but its relevance in risk stratification has not been explored. This study investigated whether early temperature elevation following aSAH predicts impending clinical deterioration caused by DCI. Relevant cases were identified from a prospectively maintained database for consecutive patients with aSAH treated at our center between July 2015 and January 2020. Temperature readings obtained every 2 hours for individual patients from admission through day 14 were recorded and analyzed. Demographic, clinical, treatment, and angiographic data were extracted from the electronic medical record. The primary end point was the occurrence of DCI (clinical and radiographic vasospasm). Multivariate logistic regression analyses were performed to account forpatient age, smoking status, and VASOGRADE classification. The study included 175 patients (124 women) with aSAH. The median age at diagnosis was 55.4 years (range, 20.5-87.2 years). Clinical DCI occurred in 58 patients; 2 (1.1%) responded to hemodynamic augmentation, and 56 (32.0%) required intra-arterial therapy. Temperature graphs showed a marked divergence on day 4 between clinical DCI and non-DCI groups (1.12°C ± 0.15°C and 0.76°C ± 0.08°C, respectively, P= 0.007). Patients with temperature elevation ≥2.5°C on day 4 or 5 compared with their admission temperature were more likely to clinically deteriorate owing to DCI (odds ratio 4.55, 95% confidence interval 1.31-15.77, P= 0.017). Temperature elevation of ≥2.5°C on day 4 or 5 compared with baseline suggests a greater risk of clinical deterioration owing to DCI.

Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5-year retrospective analysis.

This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR). This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72h of birth, bronchopulmonary dysplasia (BPD) and death. There were 491 eligible babies during the 5-year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO2 at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self-ventilating in air (SVIA) or receiving low-flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7days. At 36weeks postmenstrual age, 36% of survivors had BPD. We have demonstrated that preterm babies <32weeks can be effectively stabilised on HF in the DR.

Risk indicators associated with in-hospital mortality and severity in patients with diabetes mellitus and confirmed or clinically suspected COVID-19.

PurposeThis study aims to investigate risk indicators of in-hospital mortality and severity of coronavirus disease-2019 (COVID-19) in patients with diabetes mellitus (DM).MethodsIn this retrospective study, we studied patients with COVID-19 referred to Sina Hospital, Tehran, Iran, from February 20 to May 14, 2020. Patients with either a positive real-time reverse-transcriptase polymerase-chain-reaction test of swab specimens or high clinical suspicion according to the World Health Organization interim guidance were included. We accurately divided all patients into two groups based on diabetes affection and followed-up patients with DM based on incurring death, severe COVID-19, and in-hospital complications.ResultsWe enrolled 574 patients with COVID-19 in the final analysis, of whom 176 (30.7%) patients had DM. In this study, 104 (18.1%) patients deceased, and 380 (66.2%) patients incurred severe COVID-19. We found that COVID-19 patients with DM had a significantly higher mortality rate (P value<0.001), severe disease (P value<0.001), and in-hospital complications (all P values<0.05). Besides that, in patients with DM, admission temperature (odds ratio (OR): 1.69, P value: 0.024), oxygen saturation (OR: 0.92, P value: 0.004), and urea (OR: 1.01, P value: 0.048) were independent risk indicators of in-hospital mortality. In addition, subgroup analysis of diabetic patients based on admission glucose level showed significant differences between these groups regarding acute cardiac injury (P value: 0.044) and acute liver injury (P value: 0.002).ConclusionsPatients with DM admitted with lower oxygen saturation, elevated temperature, and higher urea are more susceptible to progress to more severe COVID-19 and poor prognosis. This indicates a necessity for more precise care during hospitalization for these patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40200-020-00701-2.

Conductive thermal mattress versus routine care to reduce neonatal hypothermia during transport among low-birthweight neonates: An experimental study with historical controls

BackgroundNeonatal hypothermia at delivery, during transport and in the postnatal wards is common, under-recognized and infrequently monitored with prevalence ranging from 32% to 85%. This study compared conductive thermal mattress to routine care for prevention of hypothermia among low-birthweight (LBW) neonates during transport. MethodsFrom July 2015 to November 2016 (historical controls), all eligible LBW neonates (1500–2499 g) were transported from the labour room/operation theatre to the neonatal intensive care unit (NICU)/postnatal wards using routine care (towels, blankets, cap, mittens and socks) and from December 2016 to December 2018 using conductive thermal mattress (EMBRACETM) Axillary temperature was measured before transport and at arrival in the NICU/postnatal wards using a digital thermometer. ResultsA total of 154 and 102 neonates were transported using conductive thermal mattress and routine care, respectively. The mean standard deviation (SD) axillary temperature at arrival in the postnatal wards in conductive thermal mattress and routine care group was 36.6 (0.6) ⁰C and 36.4 (0.5) ⁰C, respectively (p-value 0.005). Relative Risk (RR) of mild and moderate neonatal hypothermia among neonates transported using conductive thermal mattress compared to routine care group was 0.59 (0.33,1.07), number needed to treat (NNT) of 13 and 0.22 (0.04,1.07), NNT 22 respectively. ConclusionsUse of conductive thermal mattress for transport among LBW neonates led to a significant, although clinically small improvement in admission temperatures at the NICU/postnatal ward and non-significant decrease in the incidence of hypothermia.

Risk Factors of Outcomes of COVID-19 Patients in Korea: Focus on Early Symptoms.

BackgroundCoronavirus disease 2019 (COVID-19) has spread around the globe, and it is important to determine the risk factors of death in the general population. Our study aimed to determine the risk factors of death and severe illness requiring supplemental oxygen therapy based on the demographic and clinical characteristics of COVID-19 patients in Korea.MethodsIn this study, we used data provided by the Korea Disease Control and Prevention Agency (KDCA) and analyzed a total of 5,068 patients with COVID-19, excluding 19 pregnant women and 544 individuals with missing data. We performed logistic regression analysis to determine the impact of early symptoms on survival and severe disease. Logistic regression models included sex, age, number of comorbidities, symptoms on admission, blood pressure, heart rate, and body temperature as explanatory variables, and death and oxygen therapy as outcome variables.ResultsLogistic regression analyses revealed that the male sex, older age (≥ 60 years), higher number of comorbidities, presence of symptoms on admission, heart rate ≥ 120 bpm, and body temperature ≥ 37.5°C presented with higher risk of in-hospital death and oxygen therapy requirement. Conversely, rhinorrhea and headache were associated with a low risk of death and oxygen therapy requirement. The findings showed that cough, sputum, and fever were the most common symptoms on admission, while 25.3% of patients with COVID-19 were asymptomatic.ConclusionCOVID-19 patients with high-risk early symptoms on admission, such as dyspnea and altered mental status, and those without low-risk symptoms of rhinorrhea and headache should be included in priority treatment groups.

АБЕЗПЕЧЕННЯ ДОВГОВІЧНОСТІ АСФАЛЬТОБЕТОННОГО ПОКРИТТЯ НА ЖОРСТКІЙ ОСНОВІ АВТОМОБІЛЬНИХ ДОРОГАХ

The article is devoted to the development of practical methods to ensure the durability of asphalt pavement on a rigid basis of roads. The goal of the work. Practical methods of ensuring the durability of asphalt pavement on a rigid basis of roads are proposed. The object of research is asphalt-concrete pavement on a hard base of highways. Research method: analytical-experimental using the provisions of the theory of elasticity and thermo-viscoelasticity and experimental methods of research of track formation in asphalt concrete pavement on a rigid basis; mathematical statistics; statistical analysis of scientific publications, technical and normative literature. The article presents the features of the design of grain warehouses of asphalt mixtures, namely: The proposed features of the design of grain warehouses of asphalt concrete, taking into account the rate of resistance to track formation; Requirements for designing the grain composition of asphalt concrete of high resistance to track formation with optimization in terms of estimated service life are proposed. The conducted researches allowed to develop a method of estimating the homogeneity from the time of transportation of the asphalt concrete mixture in the car body to the object according to the resistance of asphalt concrete to the formation of the track. Requirements for checking the flow rate in the crushed-mastic asphalt-concrete mixture due to the terms of its storage and transportation have been developed, which avoids segregation of the coating. The criterion of strength of asphalt concrete pavement on a rigid basis of the highway is improved due to the consideration of different time of action of tensile load at bending that will allow to design more precisely a covering of the increased durability. The technique of the minimum admissible temperature of consolidation of asphalt concrete mix at the device of a covering on a rigid basis of highways that will allow to provide durability of a covering is offered for practical application. KEY WORDS: ASPHALT CONCRETE, TRACK RESISTANCE, GRAIN COMPOSITION DESIGN, TEMPERATURE, TRANSPORTATION, SEALING

Circulation of classic and recombinant human astroviruses detected in South Africa: 2009 to 2014.

Astroviruses (AstVs) are associated with diarrhoeal and extra-intestinal infections in human, animal and avian species. A prevalence of 7% was reported in selected regions in SA while AstVs detected from clinical stool specimens were almost identical phylogenetically to strains identified in environmental and water samples. This study investigated the molecular diversity of astroviruses circulating between 2009 and 2014 in South Africa (SA). Astroviruses detected in stool specimens collected from hospitalised children were investigated retrospectively. Astroviruses were characterised using type-specific RT-PCR, partial nucleotide sequence analyses in ORF1 and ORF2 and whole genome sequencing. Different genotypes were compared with clinical features to investigate genotype-related associations. The Vesikari severity scale (VSS) was evaluated for scoring astrovirus diarrhoeal infections. Of 405 astroviruses detected, 49.9 % (202/405) were characterised into 32 genotypes comprising 66.3 % (134/202) putative-recombinants and 33.7 % (68/202) classic strains. No trends by year of collection, age or site were observed. Whole genome analysis in eight strains revealed that genotypes assigned by partial nucleotide sequence analyses to five astroviruses were incorrect. Bivariate analyses showed there were no significant associations between genotypes and clinical symptoms or severity of infection. A comparison of Vesikari parameters with astrovirus-positive proxy values demonstrated that Vesikari scores for duration of diarrhoea and admission temperatures would result in a milder infection rating in astrovirus-positive cases. Diverse genotypes co-circulated with putative-recombinants predominating. Astrovirus classification was complicated by the lack of a consistent characterisation system and reliable reference database. The VSS should be used cautiously to rate astrovirus diarrhoea. While surveillance in communities and out-patient clinics must be continued, screening for human astroviruses in alternate hosts is needed to determine the reservoir species.

Systemic Markers of Injury and Injury Response Are Not Associated with Impaired Cerebrovascular Reactivity in Adult Traumatic Brain Injury: A Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study

The role of extra-cranial injury burden and systemic injury response on cerebrovascular response in traumatic brain injury (TBI) is poorly documented. This study preliminarily assesses the association between admission features of extra-cranial injury burden on cerebrovascular reactivity. Using the Collaborative European Neurotrauma Effectiveness Research in TBI High-Resolution ICU (HR ICU) sub-study cohort, we evaluated those patients with both archived high-frequency digital intra-parenchymal intra-cranial pressure monitoring data of a minimum of 6 h in duration, and the presence of a digital copy of their admission computed tomography (CT) scan. Digital physiologic signals were processed for pressure reactivity index (PRx) and both the percent time above defined PRx thresholds and mean hourly dose above threshold. This was conducted for both the first 72 h and entire duration of recording. Admission extra-cranial injury characteristics and CT injury scores were obtained from the database, with quantitative contusion, edema, intraventricular hemorrhage, and extra-axial lesion volumes were obtained via semi-automated segmentation. Comparison between admission extra-cranial markers of injury and PRx metrics was conducted using Mann-Whitney U testing, and logistic regression techniques, adjusting for known CT injury metrics associated with impaired PRx. A total of 165 patients were included. Evaluating the entire ICU recording period, there was limited association between metrics of extra-cranial injury burden and impaired cerebrovascular reactivity. Using the first 72 h of recording, admission temperature (p = 0.042) and white blood cell % (WBC %; p = 0.013) were statistically associated with impaired cerebrovascular reactivity on Mann-Whitney U and univariate logistic regression. After adjustment for admission age, pupillary status, GCS motor score, pre-hospital hypoxia/hypotension, and intra-cranial CT characteristics associated with impaired reactivity, temperature (p = 0.021) and WBC % (p = 0.013) remained significantly associated with mean PRx values above +0.25 and +0.35, respectively. Markers of extra-cranial injury burden and systemic injury response do not appear to be strongly associated with impaired cerebrovascular reactivity in TBI during both the initial and entire ICU stay.